Head and Neck Cancer: Pat's Story

MADISON – It started with a tingling sensation on her tongue. But Pat Lahart didn't think much of it.

When the sensation continued to persist, she finally went to the dentist.

"I waited longer than I should have," admitted Lahart.

When she did see the dentist, he found a tumor on the side of her tongue. He referred her to an oral surgeon who in turn sent her to an ear, nose and throat specialist. When the specialist biopsied the spot, the results came back positive for squamous cell carcinoma, a common oral cancer.

"I never thought it was cancer," said Lahart.

Head and Neck Cancers Risk Factors

Head and neck cancers account for approximately four to five percent of all cancers diagnosed in the U.S. each year, with approximately 47,000 new cases annually.

Head and neck cancer can occur in the nasal cavity, mouth, larynx, nasopharynx, oropharynx and laryngopharynx. Lahart's was on the tongue.

There are several known risk factors for head and neck cancer, including:

Tobacco use: approximately 90 percent of people with head and neck cancers use tobacco

Alcohol use: about 75-80 percent of all patients with head and neck cancer consume alcohol frequently

HPV (Human Papillomavirus): This virus may be associated with developing some head and neck cancers

"Something we would like to encourage," said Wiederholt, "is routine oral screenings by dentists."

When cancers are diagnosed early, they are approximately 70 to 90 percent curable. That rate drops to 20-40 percent the longer the cancer is allowed to develop unchecked.

Symptoms of Head and Neck Cancer

A sore on the tongue, like the one Lahart experienced, is just one symptom of head and neck cancer. Other symptoms can include:

Lump in the neck

Pain in the neck or throat

Sore on the mouth or lip

White or red patch in the mouth

Unusual bleeding, pain or numbness in the mouth or nose

Pain or difficulty with swallowing or chewing

Feelings as if something is caught in the throat

Swelling or trouble opening the jaw

Hoarseness or a change in the voice

Numbness in the face

Blocked sinuses/sinus pain

Pain in the ear

Frequent headaches

Pat's Experience with Head and Neck Cancer

After Lahart, a native of Illinois, was diagnosed, she went to a local cancer center for an evaluation. When they recommended a strong treatment of radiation, she decided to seek a second opinion. Her sister-in-law, who lives in Madison, Wisconsin, recommended the UW Carbone Comprehensive Cancer Center.

At the UW Carbone Cancer Center, Lahart met with Paul Harari, MD, a Head and Neck Cancer radiation oncologist. He recommended that Lahart first have the tumor removed surgically. A third opinion echoed Dr. Harari's recommendation, so Lahart decided to return to the UW Carbone Cancer Center for treatment.

At the UW Carbone Cancer Center, Greg Hartig, MD, otolaryngologist and Deepak Khuntia, MD, radiation oncologist, were Lahart's primary physicians. Per the original recommendation, the first step in Lahart's treatment was the removal of the tumor.

Lahart endured an 11-hour surgery conducted by Dr. Hartig, during which the tumor was removed from her tongue, along with some lymph nodes where the cancer had spread in her neck. The spot on her tongue was reconstructed using tissue from her forearm.

Following surgery, Lahart underwent a special type of radiation called Intensity-Modulated Radiation Therapy (IMRT) to kill off any remaining cancer cells while trying to preserve normal structures and limit toxic effects as much as possible.

In addition to radiation, Lahart also enrolled in a clinical trial investigating the use of Erbitux, a new targeted therapy that interferes with cancer cell growth, in combination with the primary chemotherapy agent, Cisplatin.

Wiederholt explained that researchers were investigating whether the combination of this new agent with chemotherapy would increase survival and decrease recurrence in patients with head and neck cancer who were also undergoing radiation.

When asked if she'd like to participate in the trial, Lahart said, "Let's just do it." She explained that as a patient, "You're going to do whatever you can to get rid of the cancer."

Once she concluded treatment, Lahart underwent rehabilitation under the guidance of a speech-language pathologist – learning how to eat, swallow and even talk again. Despite having nearly one third of her tongue removed, Lahart is still able to eat most food and her speech is marred only by a slight lisp.

Quality of Life Critical Element of Care

Quality of life is a critical component of head and neck cancer care at the UW Carbone Cancer Center.

"Our goal is not only to treat the cancer," commented Wiederholt, "but ensure patients are able to maintain the best quality of life possible."

Head and neck cancer can affect a patient's ability to talk, eat and even breathe. A multidisciplinary team of surgeons, radiation oncologists, medical oncologists, speech-language pathologists, nurses, social workers and even psychologists work together to treat patients, manage their symptoms, and help them regain the necessary skills for activities of daily living.

Lahart completed treatments three years ago and was recently declared cancer-free by her physician team. Wiederholt explained that is because two years is the critical milestone.

"What we know about head and neck cancers," commented Wiederholt, "is that if they reoccur, it is most likely in the first 12 to 18 months after treatment. Every year after that, the chance is less and less, providing patients have eliminated risk factors such as tobacco use."

About a year after concluding treatment, Lahart and her family spent a week in Hilton Head, South Carolina to celebrate.

"You really do look at life differently," commented Lahart. "I let things roll off. Really take stock and think about what truly is important. You appreciate life more."

Lahart credits an incredibly supportive family for helping her get through her cancer treatment.

"I had a phenomenal support system," said Lahart. "You really need that to get through cancer."

She also credits the physicians and staff at UW Carbone Cancer Center.

"Everyone is just so amazing there," she concluded. "I can't say enough about the hospital or the people."

Free Head and Neck Screenings: April 29

The UW Carbone Cancer Center is offering Free Head and Neck Cancer Screenings on April 29. It is the third year they've offered the exams.

"Last year over 100 people were screened in two hours," said Wiederholt.

During the screening, participants are told either that there were no abnormal findings or given a recommendation to follow up with a physician or an ear, nose and throat specialist. And anyone who is a smoker is given tobacco cessation materials.

"Quitting smoking is one of the most important steps you can take," commented Wiederholt.

Among the other ways to reduce the risk of developing head and neck cancer are:

Reduce alcohol consumption

Have regular physician and dentist visits

Perform regular self-checks

And if you have any concerns, speak to your primary physician or dentist.